Medical Therapy

Medical Treatment

Medical Treatment by definition is trying to manage hair loss by pharmaceutical intervention. Today it is typically with two mainstream medications and one newer technology. Two standard medical intervention therapies are is minoxidil finasteride. The newest therapy is Platelet Rich Plasma-PRP.

Minoxidil

The first Medical Treatment is Minoxidil, also known as Rogaine was developed by the Upjohn company in 1963. It was originally marketed as a blood pressure medication in 1973, Lonetin. This medication had vasodilator properties. In the trials, there was a purported side effect of hair retention and regrowth. This side effect led to the re marketing of minoxidil as Rogaine in 1988. Today minoxidil comes in many forms from oils to foams and from 2%-5% strengths. The efficacy seems to be a single applying to hair once per day as opposed to twice per day.

The mechanism of action is widely unknown however theoretically one can surmise that the local and daily vasodilation of vessels can benefit the follicle by giving more oxygen and nutrients to the follicles. This topical medication is tolerated well in most individuals with the rare exception of a massive shedding of hair temporarily Minoxidil has no deleterious effects on women as seen in the next medication below.

Finasteride

The second medical treatment is Finasteride which is the second medication to be FDA approved for hair loss. Also, known as Propecia was marketed by Merck pharmaceuticals. This medication was also first marketed for a different male issue such as prostatic hyperplasia or BPH. Again, during trials the finasteride molecule had a side effect of stopping hair loss in its tracts and some regrowing of thin follicles not yet jettisoned from the scalp. In fact, researchers found that the efficacy of this medication was only 1 mg per day orally where as BPH needed 5mg. Merck really profited from Propecia because before it finally went generic after several extensions the cost of this medication was $100+ for a 30-day supply. The work around was prescribing the BPH version that came in 5 mg and splitting the tablets into 1/4. And taking a piece every day. Today some folks take the entire 5 mg per day or take 1/5 every other day. Nevertheless, the medication is now generic and the white label use of Proscar 5 mg is written as well.

The mechanism of action of finasteride is a well-known molecule. Finasteride when in therapeutic range and consistently titrate based consumption will absolutely block the conversion of testosterone into di-hydrotestosterone (DHT). DHT is the causing molecule that attaches to receptors on the genetic MPB male hair follicle and causes a destruction slow death the follicle. The 5-alpha reductase inhibitor competes for the same receptor in the hair follicle and thus reduces binding of DHT.

In the last few years, there has been an increase on the internet of sexual issues when using finasteride. Finasteride is widely tolerated however on very small <1.0% of hundreds of thousands of men reported some issues of impotence. Out of this small percentage, 60% of those guys had a resolution after a few months of usage. The rest resolved after complete cessation. Today there are rare reports on permanent impotence however these cases have not been studied and ruled out for other underlying medical complications. In our STRONGEST opinion, finasteride should be a first line of defense at the earliest of age when seeing hair loss. There are troves of young men out there that still to this day do not realize at the age of 18 and already a Norwood 3, can actually stop further loss.

Finasteride is not to be handles at all during a pregnancy. Even touching the pills could pose a hazard to a fetus. Also, many men stop using the medication all together when trying to become pregnant and continue the therapy after the child is born.

There is one other medication used for hair loss but rarely. Duetasteride also known as Avodart is a duel 5-Alpha DHT blocker. However, it is rarely prescribed now days and is known for a plethora of male issues let alone for women in child bearing years.

Platelet Rich Plasma or PRP is a newer technology that has been proven by the scientific method which is a repeated method of research to prove theories in science. This is rare in hair restoration. However PRP has had great strides since its inception in many areas of medicine. And it eventually made it ti hair loss.

The premise behind and methods are as follows:

Your own whole blood is drawn in sodium citrate “Tiger blue top” tube. The blood is then centrifuged twice. Once at a soft spin and the second time at a hard spin. This separates the platelet poor plasma (PPP) from the pure PRP. PRP is then injected around the scalp in the areas that are having hair loss. We also use it post op FUE hair transplants because of its proven healing times. Post operatively the transplanted follicles are able to heal in much more quickly than without PRP. We provide a free PRP just after our transplants. Click here for US Library of Medicine NIH publication for PRP ⊕